Today, 8th October is World Hospice and Palliative Care Day. I would like to take this opportunity to thank all of you who support Asociación Girasol here in the northern part ofAntequera,Spain: Alameda, Fuente de Piedra, Humilladero, and Mollina, for the fantastic work you are doing.

We send a big hug to our colleagues: Cudeca who are representingSpainin “Voices for Hospices 2011”

And I would like to tell you about a wonderful thing that happened today. I received a call from one of our supporters saying that she had remembered that it was World Hospice and Palliative Care Day, and she wanted to give us something that her daughter had made to sell to raise funds for our cause. She arrived on my doorstep with a bag of lovely, hand-made rings: pure craftsmanship: all different, and beautiful, and they will be in our stall at Saydo, next week.

I cannot express the gratitude I feel for this day. We appreciate the voluntary work done by all, and above all, we remember our loved ones and carers

The volunteer should listen openly to any request that the patient may have, help to resolve outstanding matters, reconcile situations and reach forgiveness, help him/her to say goodbye, and ensure the patient has total freedom of expression regardless of his/her religious beliefs whatever they may be.

The time draws closer, we still have two days: the first day to meet with the those who we have hated and the second to meet with those we have loved. To some, we will ask forgiveness for our hatred, and to others Love. In this way we will lighten both weights and can move forward unburdened to the frontier” (Rafael Argullol)

Palliative care includes a wide range of needs which are specific to the individual. The physical and emotional effects of cancer vary from person to person and depend upon such factors as: age, cultural background, available support systems which mean that the palliative care given will differ.

Palliative care takes into account the following:

Physical needs: the most common physical symptoms include: pain, tiredness, loss of appetite, nausea, sickness, difficulty in breathing and insomnia. Many of these symptoms can be relieved by medication or by other methods: diet, physiotherapy, deep-breathing exercises. Chemotherapy, radiotherapy, and surgery can reduce tumours which are causing pain and other problems.

Emotional needs: palliative care specialists can provide resources to help patients and families confront the emotions which accompany cancer diagnosis or treatment. Depression, anxiety, and fear are only a few of the worries that can be relieved through palliative care. Specialists can evaluate, recommend support groups, family get-togethers, or make referrals to the mental health specialists.

Practical needs: Cancer patients can experience financial and legal problems, may have questions about insurance, or fear for their jobs. For many patients and family members technical and legal language and forms are difficult to understand. To lighten the burden the palliative care team can help to coordinate the appropriate services. For example: the team can direct patients and their families to the where they can obtain help with finances, to understand medical forms or legal matters, local or national resources such as help with transport, or housing.

Spiritual needs: With a cancer diagnosis patients and families usually seek the meaning of life more profoundly. Some people find the experience deepens their faith, others question it trying to understand why cancer has happened to them. A palliative care expert can help people explore their beliefs and values and find peace or acceptance of their situation.

The patient, friends, and family unit is fundamental for palliative care. It is not easy for any person to confront the situation that their loved one needs more of their care. Continuous support is a great help to any family: help in the home and emotional help.

The support and help offered to families, carers, and friends should start as soon as the illness is diagnosed which is one of the most stressful moments, and continue post bereavement when family, friends, and carers feel most alone but appear fine.

Active listening is a useful tool which allows emotions, and needs to be expressed, and hope to be maintained. This is not believing in that a cure can be found but reinforces the positive attitudes of family members, carers and friends.

The factor that helps us most to die in peace is to be able to feel close to, to communicate with, and to have a tight bond with our loved ones, that means, being able to express our feelings and to feel loved.

It is possible to have a good death when an atmosphere of adequate communication between the patient and those who care for him/her exists, if the patient knows about, and participates in his/her treatment, if painful symptoms are relieved, and if the family does not feel alone and receives social as well as medical support.

Clinical evidence shows us doctors, what we have done badly and what we have done well in our clinical practice, and thanks to that we are able to establish the systems to follow with our patients. That group of patients who have a terminal illness that ends in painful death, and their families who suffer in so many different ways, have been cared for by well intentioned people and doctors who, in silence, have dedicated themselves to relieve the suffering and have done their best to improve the quality of life of these patients. For years this care has been the responsibility of professional health teams supported by charities.

Who would question that we can all do palliative care? A great friend, believer in palliative care, showed me that everyone is capable of offering palliative care. It all depends on awareness and commitment.